300 removal of the exciting eyeball arrests further advance; but frequently progress is much more insidious. There may be at first no pain, merely a loss of accommodative power, followed in sequence by turbid aqueous, ciliary renderness, vitreous opacity, detached retina, and permanent loss of sight. Whence the good practice of removing every eyeball so injured that it may likely set up this state in the other. When an eyeball is hopelessly damaged, when it contains any considerable or

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... y unclean foreign body, no surgeon hesitates about its removal. But difficult and anxious questions arise with such injuries as only damage but do not destroy sight, and in some instances it is justifiable to watch and wait. A considerably injured eyeball which heals rapidly and well may yet be useful and safe. Ablation and evisceration of the contents of the eyeball are said to be equally certain with removal and to leave better stumps, but the direction of recent investigation does not favour this view. It is very probable that the infection of the sympathising eye is through the communicating lymph spaces of the optic nerves, and consequently the further back the removal of the exciting organ the better is the prospect of prevention. We now recognise this principle in the treatment of depressed fracture of the skull with or without external wound. Our knowledge of the subsequent influence on the brain of irregularities of the vault leads us to operate whenever this injury occurs, and we prevent the ccrtical irritation or inhibition which wa anticipate may follow leaving matters alone. In fractures of the patella many surgeons at once suture the fragments together to prevent fibrous union and a tedious recovery. Divided nerves and tendons when divided by accident are constantly sutured to prevent the loss of power which follows the separation of their ends. When considerable portions of bones, nerves, or tendons have been lost by accident they may be successfully replaced by the implantation of similar structures taken from other human beings or animals. This (the implantation) is perhaps the most highly finished example of applied surgical knowledge and skill, and bears somewhat the same relation to ordinary surgery as the masterpiece of the artist does to the everyday work of the artisan. THE PREVENTION OF SURGICAL DISEASES 1 . , , . I do not think that we should look upon our work in regard to operative surgery as finished when we have suggested , , treatment or performed operations. I think rather we ought to be the teachers of the public : that we should show them, as far as our knowledge goes, what are the antecedent evils and errors which produce surgical disease and the methods of preventing such. We have still, and ever shall have, much to learn ourselves. For instance, I strongly believe that at present we do not sufficiently appreciate the harm of slight persistent contamination of the air we breathe. Very often adenoid growth in the pharynx, enlarged tonsils, and consecutive middle-ear disease, which are so common as a clinical sequence, occur in houses which are to all appearance hygienically good. They occur here among the well-off in a larger proportion than among the working classes or the poor, among those occupying modern roomy houses which apparently do not expose their inmates to the breathing of poisoned air more than among those whose circumstances oblige them to live in overcrowded little rooms. But modern houses have their waterclosets, their waste pipes, and their various-often complicated-sanitary appliances inside them, the old and small houses have them outside. I have been in the habit for many years of urging an examination by a skilled inspector of every house in which my attention was called to repeated sore-throats or such disease as I have just mentioned, and in no instance has there been failure to find such fault as allowed air contamination, sometimes direct communication with the main sewer, but more frequently such a state of matters as allowed a portion only of the house system to be for ever breeding and discharging into the air the products of putrefactive change. While it is true preventive surgery to remove adenoids or clean out and drain the recesses of a suppurating ear and prevent a brain abscess, it is unquestionably a higher art, a nobler science, which stops the original cause of all. We alone who see the whole chain of linked causes and effects can show how such evils may be avoided. As another example in the case of teeth I am certain that it is not sufficiently known how dangerous they are when dead and putrid. Few things exist which are more septic. I have never taken cultures from one ; others have and have put on record the various organisms which have been found; but I have often seen the culture experiment in the living bodyan experiment convincing enough on the score of activity. I have seen rapid death from general infective disease or putrid thrombosis, with abscesses in the chest or cranium, originating in a dead fang. Extensive neck abscesses are no uncommon result from the same source, and in slower forms with feebler infective powers there may be a continuous slight constitutional poisoning with occasional rises of temperature, presenting a singular resemblance to phthisis. In cases of gastric ulcer I have made a practice for some years of examining the teeth, and in every instance have found decayed teeth or stumps in bad condition or a story of their recent removal. Whether this coincidence amounts to cause and effect I know not. I think, however, it may. It seems a reasonable explanation of the occurrence of ulcer that any accidental abrasion of the epithelial lining of the stomach (and doubtless such are common from food, fish. bones, seeds, &c.) is kept in contact with food or saliva containing septic organisms derived from the mouth. Our daily experience tells us what occurs when a raw surface is in contact with unclean discharges. I might multiply examples, but I have said enough to illustrate in what directions our work may go. Perhaps the besetting sin of surgery is that it has a narrowing tendency. We must put into our work all our thought and knowledge. Whatsoever our hands find to do that must we do with all our might. Superficiality means failure. The human interest of all we do is intensely absorbing, consequently there is just the risk of looking upon surgery as a thing by itself and of losing our sense of its true place and proportion and confining our thoughts within a groove of little breadth. In preventive surgery we have a tendency in an opposite direction. This tendency not only brings us into immediate contact with what the physician and general practitioner is thinking and doing, making our life and work a portion of the vast organisation for the prolongation of existence, the diminution of suffering, and the prevention of disease, which we are proud to consider as the reason of our existence, but it still further associates us with the great mass of scientific and intellectual advancement which lies outside the limits of any profession of any nation and of any time.